scholarly journals High Oxygen Does Not Increase Reperfusion Injury Assessed with Lipid Peroxidation Biomarkers after Cardiac Arrest: A Post Hoc Analysis of the COMACARE Trial

2021 ◽  
Vol 10 (18) ◽  
pp. 4226
Author(s):  
Jaana Humaloja ◽  
Maximo Vento ◽  
Julia Kuligowski ◽  
Sture Andersson ◽  
José David Piñeiro-Ramos ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Life Support ◽  
Ischemia Reperfusion ◽  
Oxidative Injury ◽  
Arterial Oxygen ◽  
Blood Samples ◽  
Oxygen Exposure

The products of polyunsaturated fatty acid peroxidation are considered reliable biomarkers of oxidative injury in vivo. We investigated ischemia-reperfusion-related oxidative injury by determining the levels of lipid peroxidation biomarkers (isoprostane, isofuran, neuroprostane, and neurofuran) after cardiac arrest and tested the associations between the biomarkers and different arterial oxygen tensions (PaO2). We utilized blood samples collected during the COMACARE trial (NCT02698917). In the trial, 123 patients resuscitated from out-of-hospital cardiac arrest were treated with a 10–15 kPa or 20–25 kPa PaO2 target during the initial 36 h in the intensive care unit. We measured the biomarker levels at admission, and 24, 48, and 72 h thereafter. We compared biomarker levels in the intervention groups and in groups that differed in oxygen exposure prior to randomization. Blood samples for biomarker determination were available for 112 patients. All four biomarker levels peaked at 24 h; the increase appeared greater in younger patients and in patients without bystander-initiated life support. No association between the lipid peroxidation biomarkers and oxygen exposure either before or after randomization was found. Increases in the biomarker levels during the first 24 h in intensive care suggest continuing oxidative stress, but the clinical relevance of this remains unresolved.

scholarly journals MDMA Intoxication in a Potential Organ Donor with Cardiac Arrest

2020 ◽  
Vol 44 (8) ◽  
pp. 923-926
Author(s):  
André L Castro ◽  
Sónia Tarelho ◽  
Dina Almeida ◽  
Lara Sousa ◽  
João Miguel Franco ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Whole Blood ◽  
Life Support ◽  
Advanced Life Support ◽  
Organ Donor ◽  
Mass Spectrometry Analysis ◽  
Blood Samples ◽  
Potential Organ Donor ◽  
Whole Blood Samples

Abstract Amphetamine and its derivatives’ consumption is still an important public health issue, namely in terms of compounds variability and disposition to consumers. However, some of them, like 3,4-methylenedioxymethamphetamine (MDMA), still live in the illicit market, with continuous success. Nevertheless, there is always new information and data on MDMA intoxication, both in vivo and in postmortem context. The authors report an intoxication case with MDMA, in an 18-year-old male, considered a potential organ donor after a cardiac arrest. Whole blood samples were collected in vivo, at the emergency room (ER), and postmortem, at the National Institute of Legal Medicine and Forensic Sciences. After a general screening procedure, samples were extracted by solid phase extraction (OASIS® MCX), followed by gas chromatography–mass spectrometry analysis. The whole blood postmortem sample was positive for lidocaine (<500 ng/mL), compatible with the ER intervention, and positive for MDMA (2278 ng/mL) and methylenedioxyamphetamine (MDA) (49 ng/mL), while whole blood samples collected in vivo (during the maintenance of the individual under advanced life support), were positive for MDMA (504–1918 ng/mL) and MDA (20–89 ng/mL). Samples were negative for other substances, namely ethanol, other drugs of abuse and medicines. Results interpretation is pivotal to understand the behavior of the substance. Thus, in this case, MDMA postmortem behavior should be carefully evaluated, considering as possible influencers, in the specific context of the case, the time lapse between death verification, maintenance of the advanced life support and body manipulation for organ collection purposes. Also referred and discussed is the antemortem/postmortem ratio of MDMA obtained values, compared with literature references. There is no doubt that death was due to MDMA intoxication, but information from the analysis performed on the in vivo samples suggests that this type of sample should also be considered, in a complementary role, whenever possible.

scholarly journals Fingolimod Plays Role in Attenuation of Myocardial Injury Related to Experimental Model of Cardiac Arrest and Extracorporeal Life Support Resuscitation

2019 ◽  
Vol 20 (24) ◽  
pp. 6237 ◽  
Author(s):  
Naseer Ahmed ◽  
Abid H. Laghari ◽  
Bashar AlBkhoor ◽  
Sobia Tabassum ◽  
Sultan Ayoub Meo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Myocardial Dysfunction ◽  
Ischemia Reperfusion ◽  
Receptor Activation ◽  
Health Concern ◽  
Myocardial Oxidative Stress

Background: Sudden cardiac arrest is a major global health concern, and survival of patients with ischemia–reperfusion injury is a leading cause of myocardial dysfunction. The mechanism of this phenomenon is not well understood because of the complex pathophysiological nature of the disease. Aim of the study was to investigate the cardioprotective role of fingolimod in an in vivo model of cardiac arrest and resuscitation. Methods: In this study, an in vivo rat model of cardiac arrest using extracorporeal membrane oxygenation resuscitation monitored by invasive hemodynamic measurement was developed. At the beginning of extracorporeal life support (ECLS), animals were randomly treated with fingolimod (Group A, n = 30) or saline (Group B, n = 30). Half of the animals in each group (Group A1 and B1, n = 15 each) were sacrificed after 1 h, and the remaining animals (Group A2 and B2) after 24 h of reperfusion. Blood and myocardial tissues were collected for analysis of cardiac features, inflammatory biomarkers, and cell signaling pathways. Results: Treatment with fingolimod resulted in activation of survival pathways resulting into reduced inflammation, myocardial oxidative stress and apoptosis of cardiomyocytes. This led to significant improvement in systolic and diastolic functions of the left ventricle and improved contractility index. Conclusions: Sphingosine1phosphate receptor activation with fingolimod improved cardiac function after cardiac arrest supported with ECLS. Present study findings strongly support a cardioprotective role of fingolimod through sphingosine-1-phosphate receptor activation during reperfusion after circulatory arrest.

Exercise training improves myocardial tolerance to in vivo ischemia-reperfusion in the rat

1998 ◽  
Vol 275 (5) ◽  
pp. R1468-R1477 ◽  
Author(s):  
Scott K. Powers ◽  
Haydar A. Demirel ◽  
Heather K. Vincent ◽  
Jeff S. Coombes ◽  
Hisashi Naito ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Exercise Training ◽  
Endurance Exercise ◽  
Ischemia Reperfusion ◽  
Experimental Studies ◽  
Control Group ◽  
Sprague Dawley ◽  
Endurance Exercise Training ◽  
Nonprotein Thiols

Experimental studies examining the effects of regular exercise on cardiac responses to ischemia and reperfusion (I/R) are limited. Therefore, these experiments examined the effects of endurance exercise training on myocardial biochemical and physiological responses during in vivo I/R. Female Sprague-Dawley rats (4 mo old) were randomly assigned to either a sedentary control group or to an exercise training group. After a 10-wk endurance exercise training program, animals were anesthetized and mechanically ventilated, and the chest was opened by thoracotomy. Coronary occlusion was achieved by a ligature around the left coronary artery; occlusion was maintained for 20 min, followed by a 10-min period of reperfusion. Compared with untrained, exercise-trained animals maintained higher ( P < 0.05) peak systolic blood pressure throughout I/R. Training resulted in a significant ( P < 0.05) increase in ventricular nonprotein thiols, heat shock protein (HSP) 72, and the activities of superoxide dismutase (SOD), phosphofructokinase (PFK), and lactate dehydrogenase. Furthermore, compared with untrained controls, left ventricles from trained animals exhibited lower levels ( P < 0.05) of lipid peroxidation after I/R. These data demonstrate that endurance exercise training improves myocardial contractile performance and reduces lipid peroxidation during I/R in the rat in vivo. It appears likely that the improvement in the myocardial responses to I/R was related to training-induced increases in nonprotein thiols, HSP72, and the activities of SOD and PFK in the myocardium.

scholarly journals Cardiorespiratory physiological perturbations after acute smoke-induced lung injury and during extracorporeal membrane oxygenation support in sheep

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 769
Author(s):  
Saul Chemonges
Keyword(s):  
Intensive Care ◽  
Lung Injury ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Lung Compliance ◽  
Smoke Inhalation ◽  
Biological Information ◽  
Arterial Oxygen ◽  
Physiological Data ◽  
Coronary Perfusion

Background: Numerous successful therapies developed for human medicine involve animal experimentation. Animal studies that are focused solely on translational potential, may not sufficiently document unexpected outcomes. Considerable amounts of data from such studies could be used to advance veterinary science. For example, sheep are increasingly being used as models of intensive care and therefore, data arising from such models must be published. In this study, the hypothesis is that there is little information describing cardiorespiratory physiological data from sheep models of intensive care and the author aimed to analyse such data to provide biological information that is currently not available for sheep that received extracorporeal life support (ECLS) following acute smoke-induced lung injury. Methods: Nineteen mechanically ventilated adult ewes undergoing intensive care during evaluation of a form of ECLS (treatment) for acute lung injury were used to collate clinical observations. Eight sheep were injured by acute smoke inhalation prior to treatment (injured/treated), while another eight were not injured but treated (uninjured/treated). Two sheep were injured but not treated (injured/untreated), while one received room air instead of smoke as the injury and was not treated (placebo/untreated). The data were then analysed for 11 physiological categories and compared between the two treated groups. Results: Compared with the baseline, treatment contributed to and exacerbated the deterioration of pulmonary pathology by reducing lung compliance and the arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio. The oxygen extraction index changes mirrored those of the PaO2/FiO2 ratio. Decreasing coronary perfusion pressure predicted the severity of cardiopulmonary injury. Conclusions: These novel observations could help in understanding similar pathology such as that which occurs in animal victims of smoke inhalation from house or bush fires, aspiration pneumonia secondary to tick paralysis and in the management of the severe coronavirus disease 2019 (COVID-19) in humans.

scholarly journals Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Edward Gologorsky ◽  
Francisco Igor B. Macedo ◽  
Enisa M. Carvalho ◽  
Angela Gologorsky ◽  
Marco Ricci ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Heart Surgery ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Neurological Function ◽  
Paradigm Change

Early institution of extracorporeal perfusion support (ECPS) may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU) following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes) advanced cardiac life support (ACLS) protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

scholarly journals Neuroglobin Protects Neurons against Oxidative Stress in Global Ischemia

2010 ◽  
Vol 30 (11) ◽  
pp. 1874-1882 ◽  
Author(s):  
Richard Changxun Li ◽  
Shang Zhi Guo ◽  
Seung Kwan Lee ◽  
David Gozal
Keyword(s):  
Lipid Peroxidation ◽  
Transgenic Mice ◽  
Reperfusion Injury ◽  
Cell Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Antioxidant Properties ◽  
Cresyl Violet ◽  
Transgenic Mouse Line

Neuroglobin (Ngb) is a recently discovered globin that affords protection against hypoxic/ischemic-induced cell injury in brain. Hypoxic/ischemic injury is associated with accumulation of reactive oxygen species (ROS) and/or reactive nitrogen species (RNS). In previous studies, we found that Ngb has antioxidative properties, and protects PC-12 cells against hypoxia- and β-amyloid-induced cell death. To further delineate the potential role of Ngb in protection against cerebral ischemia–reperfusion injury in vivo, we developed a transgenic mouse line that overexpresses Ngb. Hippocampal ischemia–reperfusion injury was induced by a 10-minute bilateral occlusion of the common carotid arteries, and the animal brains were assessed 3 days later. CA1 neural injury was determined by cresyl violet staining. Lipid peroxidation was assessed using a malonyldialdehyde assay kit, whereas ROS/RNS accumulation was determined by Het staining in the CA1 hippocampal region. Hippocampal Ngb mRNA and protein expressions were assessed by reverse transcriptase-PCR and western blotting, respectively. Neuroglobin was successfully overexpressed in the hippocampus of Ngb transgenic mice. After ischemia–reperfusion, CA1 ROS/RNS production and lipid peroxidation were markedly decreased in Ngb transgenic mice compared with wild-type mice. Furthermore, CA1 neuronal injury was also markedly reduced. Thus, Ngb may confer protection against ischemia–reperfusion injury in the brain through its intrinsic antioxidant properties.

scholarly journals Resuscitation After Cardiac Surgery Awareness an Egyptian Multicentre Survey

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Moslem Abdelghafar ◽  
Taher Abdelmoneim ◽  
Alaa Mohamed ◽  
Mohamed Abdalla
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Life Support ◽  
Action Plan ◽  
Care Staff ◽  
Annual Number ◽  
Cardiac Massage ◽  
Average Percentage ◽  
Shockable Rhythm

Abstract Introduction There has been an increasing recognition that cardiac surgery patients have different resuscitative needs than other medical and surgical patients who experience in-hospital cardiac arrest. This was addressed in the 2010 European Resuscitation Council Guidelines and the 2010 American Heart Association Guidelines. However, it’s unknown how widely the guidelines are practiced, or a training protocol is followed in different units in Egypt. Objectives This national survey aims to identify the views and common practice of Egyptian cardiac teams regarding resuscitation after cardiac surgery. Methods A 21-question survey is created based on a prior survey used by the EACTS guidelines committee. Questions included the following topics: Participants demographics, Prevalence of cardiac arrest in the intensive care unit, Cardiac arrest with ventricular fibrillation or non-shockable rhythm, Emergency resternotomy technique, Training and arrest protocols. Survey dissemination was through social media platforms, mobile messaging applications and emails during the time period between November 2020 and January 2021. Results Of 126 responses, 95 were suitable for inclusion. Responses were from 11 centres across Egypt. 68.5% of the respondents were surgeons while cardiac anaesthetists and intensivists formed 12.6% and 18.9% respectively. 76.8% of participants were middle-grade doctors, consultant participation was 23.2%. The median annual number of cases performed in the units was 480 and this ranged from 10 to 3000. The average percentage of cardiac arrests was 7%, Median survival to hospital discharge of all arrests was 33% For patients who go into VF after cardiac surgery, respondents would attempt a mean of 5 shocks with only 24.2% commencing defibrillation shocks before external cardiac massage, while the majority initiating CPR immediately. They would perform emergency resternotomy in a mean time of 12 mins and in 15 mins if the rhythm was not shockable. 56.8% would give 1 mg of adrenaline as soon the cardiac arrest was established, only 6.3% thought that it should be given rarely or not at all. If a surgeon was not immediately available 36.8% of respondents would be happy for any trained personnel to perform the emergency resternotomy while 58.9% expect only the surgeon to perform the resternotomy. 49.4% of the participants have not practised any training to perform an emergency sternotomy. 41% of the respondents state they occasionally practice or talk with the staff about it. Only 9.5% practice regularly on emergency sternotomies. 25% assume current training is enough and does not need modification, while 75% think tailored training is important and staff should be oriented about it in the future. Conclusion An action plan is required to improve the awareness of the junior surgeons with the Cardiac Advanced Life Support Protocol. Proper training of the intensive care staff to implement the protocol in a timely organised manner is needed. Assessment of the rhythm before starting external chest compressions is the corner stone in cardiac patients undergoing cardiac arrest. VF/pVT rhythm, 3 defibrillation shocks are given first; for the non- shockable rhythm, the emergency pacing switched on, this is followed by compressions till resternomtomy. Emergency resternotomy under 5 minutes is the only effective way to save patients with tamponade and extreme hypovolemia.

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